Medical Statement Flow Chart - WI Child Nutrition Programs (FNS)

CACFP Meal Requirements for Lifestyle Choices
Special dietary practices such as eating vegetarian, organic or eliminating certain foods for religious reasons are not exempt from the CACFP meal
pattern meaning the full meal pattern must be supplied by the center in order to claim the meal for reimbursement. If a meal component is eliminated
because of dietary practices, or if the parent/guardian supplies any component of the meal, the center cannot claim the meal for reimbursement. The
only exception to this is with serving a non-dairy milk substitute.
Is there a medical reason for the parent/guardian wanting their child to drink something other than regular cow’s milk?
Is there a medical statement from a medical authority on file including:
the reason for the milk substitution
a statement that milk is to be omitted from the child’s diet
the type of non-dairy milk or other beverage that may be substituted
YES
Does the
parent/guardian
or center supply
the substitute?
Yes
Yes
NO
Does the center supply a creditable
dairy milk substitute (e.g. low-fat or fatfree
lactose-free, lactose-reduced,
buttermilk or acidified milk)?
No
Does the parent/guardian supply a
non-dairy milk substitute?
No
The parent/guardian may request in writing that their child be
served a non-dairy milk substitution. The request should include:
the reason for the non-dairy milk substitution (i.e. life style choice)
the specific type of non-dairy beverage to be substituted
o the substitution must be nutritionally equivalent to milk and
meet all of the nutritional standards for fortification of
calcium, protein, vitamins A and D and other nutrients to levels
found in cow’s milk listed below:
Milk Substitute Nutrition Standards
Nutrient Per Cup
Calcium
276 mg
Protein
8 g
Vitamin A 500 IU
Vitamin D 100 IU
Magnesium 24 mg
Phosphorus 222 mg
Potassium 349 mg
Riboflavin .44 mg
Vitamin B-12 1.1mcg (μg)
See list of approved non-dairy beverages in GM #12C
Center can
claim the
meal(s) for
reimbursement
Yes
No
Center cannot claim
the meal(s) for
reimbursement
Yes
Center can claim
the meal(s) for
reimbursement
Yes
Does the parent /guardian or center supply one
of the approved substitutes?
No
Does the parent/guardian or
center supply an
unapproved substitute?
Center cannot
claim the
meal(s) for
reimbursement